| Abstract | Prema ESHRE/ASRM 2003 definiciji, za dijagnozu sindroma policističnih jajnika (PCOS) potrebno je utvrditi barem dva od tri sljedeća obilježja: oligo/anovulaciju (OA), hiperandrogenizma (HA) i policističnu morfologiju jajnika (PCOM). Tako su i nehiperandrogene žene s PCOM i OA uključene u PCOS (neHA-PCOS). Istraživanja koja su se bavila metaboličkim statusom žena s nehiperandrogenim PCOS-om nisu polučila jednoznačne zaključke što je dovelo do prijedloga za isključivanje tog fenotipa iz PCOS-a. Međutim, u tim istraživanjima se, kao klinički biljeg za OA, uglavnom koristila oligo/amenoreja (OAM). S obzirom da je granična vrijednost intermenstruacijskog raspona (IMR) za definiciju OAM postavljana arbitrarno, različiti zaključci su, potencijalno, odraz metodoloških razlika u tim istraživanjima. Cilj istraživanja: Ustanoviti postoji li povezanost između IMR i metaboličkih obilježja u nehiperandrogenih žena s policističnom morfologijom jajnika (neHA-PCOM), odrediti graničnu vrijednosti IMR koja razdjeljuje neHA-PCOM žene prema metaboličkom riziku, usporediti metabolički status nehiperandrogenog fenotipa PCOS-a, hiperandrogenih fenotipova PCOS-a, kontrolne skupine s PCOM (PCOM-CTRL) i kontrolne skupine s urednom morfologijom jajnika (CTRL). Ispitanici i metode: Ispitanice (N=555) su razvrstane u tri skupine prema ESHRE/ASRM 2003 definiciji: CTRL (n=167), neHA-PCOM (n=250) i HA-PCOS (n=138). Metabolički status je procjenjivan na temelju: indeksa tjelesne mase (ITM), opsega struka, homeostatskog modela procjene inzulinske rezistencije (HOMA-IR), indeksa visceralne debljine (IVD), koncentracija triglicerida (TG) te ukupnog (TC) i kolesterola u lipoproteinima niske (LDL-C) i visoke (HDL-C) gustoće. Rezultati: U neHA-PCOM skupini ustanovljena je povezanost IMR s ITM, OS, HOMA-IR te TG, TC, HDL-C, LDL-C i IVD. Pokazano je da IMR>45 dana ima najveću vrijednost u identifikaciji neHA-PCOM ispitanica s nepovoljnim metaboličkim statusom. Ustanovljeno je da neHA-PCOS i HA-PCOS ispitanice imaju sličan metabolički status i nepovoljniji u odnosu na POM-CTRL i CTRL ispitanice. Metabolički status u nehiperandrogenom fenotipu PCOS-a je bio sličan hiperandrogenom, normoovulatornom fenotipu PCOS-a i povoljniji od oligo/anovulatornog, hiperandrogenog fenotipa PCOS-a. Zaključak: Menstruacijski ciklus dulji od 45 dana identificira neHA-PCOM žene s nepovoljnim metaboličkim statusom. Sličan metabolički status ustanovljen je u nehiperandrogenih žena s menstruacijskim ciklusom duljim od 45 dana i hiperandrogenih žena s PCOS-om što govori u prilog dijagnozi PCOS-a prema ESHRE/ASRM 2003 definiciji. |
| Abstract (english) | According to the ESHRE/ASRM 2003 definition, polycystic ovary syndrome (PCOS) diagnosis requires the presence of at least two of the following criteria – oligo/anovulation (OA), hyperandrogenism (HA) and polycystic ovarian morphology (PCOM), and the exclusion of other endocrinologic disorders presenting with similar clinical manifestations. Thus, by ESHRE/ASRM 2003 definition, non-hyperandrogenic PCOS is defined by the presence of both, PCOM and OA. More recent proposal of PCOS diagnostic criteria (AES, 2006), driven by undetermined metabolic risks of non-hyperandrogenic phenotype, did not include it in PCOS. Several methodological issues emerging form ESHRE/ASRM 2003 PCOS definition could lead to this divergence. ESHRE/ASRM 2003 definition did not provide the methodology for OA determination. Due to the complexity of determining OA by serial ultrasonography or serial hormone measurements, the studies investigating the metabolic status of non-hyperandrogenic PCOS usually use oligo/ammenorrhoea (OAM) as a clinical surrogate marker for OA. However, the intermenstrual ranges (IMR) used for OAM were imposed arbitrarily and differentiate from one study to another which leads to the heterogeneity of study participants, both non-hyperandrogenic PCOS and controls, and, finally, to the unequivocal study results. Altogether, this could explain why the metabolic status of non-hyperandrogenic phenotype of PCOS with respect to healthy controls is still matter of an ongoing debate. Objective: To investigate associations between IMR and metabolic markers in non-hyperandrogenic women with polycystic ovarian morphology (neHA-PCOM), to determine the threshold for IMR able to discriminate neHA-PCOM participants according to their metabolic risk and to compare the metabolic status of both neHA-PCOS and PCOM groups with controls and HA-PCOS. Participants and methods: Participants (N=555) were separated in three groups according to ESHRE/ASRM 2003 criteria: CTRL (n=167), neHA-PCOM (PCOM+OA; n=250) and HA-PCOS (n=138). Metabolic status was assessed using: body mass index (ITM), waist circumference (OS), homeostatic model of insulin resistance assessment (HOMA-IR), visceral adiposity index (IVD), concentration of triglycerides (TG) and total (TC), low density lipoprotein (LDL-C) and high density lipoprotein (HDL-C) cholesterol. Results: The associations between IMR and ITM, OS, HOMA-IR, TG, TC, HDL-C, LDL-C and IVD were found in non-hyperandrogenic participants with polycystic ovarian morphology. In this group, IMR>45 days demonstrated the best performance in identifying participants with unfavorable metabolic status. Non-hyperandrogenic PCOS and HA-PCOS group showed similar metabolic statuses which were more unfavorable in comparison with PCOM-CTRL and CTRL groups. Metabolic status in non-hyperandrogenic PCOS was similar to PCOS C and more favorable than in PCOS A. Conclusion: Among non-hyperandrogenic women with polycystic ovaries, menstrual cycle length >45 days could identify those with unfavorable metabolic status. Using that criterion for definition of oligo/anovulation, non-hyperandrogenic PCOS and HA-PCOS was found to have similar metabolic status which speaks in favor of inclusion of this phenotype in PCOS as suggested by ESHRE/ASRM 2003 definition. |
